Optimal effectiveness of heart failure management: an umbrella review examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

Abstract

Introduction: Heart Failure (HF) is a major health concern. It is the diagnosis with the highest readmission rates among all diseases. Nevertheless, it is estimated that up to 40% of hospitalizations are preventable. Yet, there remains a knowledge gape concerning which interventions contribute to effective prevention of HF hospitalization or readmission. Purpose: This umbrella review, therefore, aims to systematically review all published meta-analysis conducted in the past 10 years that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in heart failure patients. Methods: An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL and Medline to identify eligible studies published in English language from January 2010 up to the end of June 2020. To synthesize the data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Results: A total of 54 meta-analyses were included which encompassed 262 unique RCTs (Figure 1). Strong evidence suggested that cardiac rehabilitation was inversely related to heart failure hospitalization. Furthermore, moderate evidence was found for the effectiveness of telemonitoring, loop diuretics and RAAS inhibitors in reducing HF-related hospitalizations. Furthermore, limited evidence suggested that multidisciplinary clinic or selfmanagement promotion programs, catheter ablation, mitral valve therapy, CRT, SLGT-II inhibitors, statins, or ultrafiltration were negatively related to HF-hospitalization. Additionally, there remains conflicting evidence regarding the effect of cell therapy on HF-hospitalization. No evidence was found that anticoagulation or class II antiarrhythmics could reduce HF-related hospitalizations. Conclusion(s): This umbrella review is the first known review to highlight different levels of evidence regarding the effectiveness of several interventions in reducing HF-related hospitalization. It could guide future guideline development in optimizing care pathways for heart failure patients.